BPSTEST1 ;OAK/ELZ - ECME TESTING TOOL ;11/15/07 09:55
;;1.0;E CLAIMS MGMT ENGINE;**6,7,8,10,11,15,19,20,22,26**;JUN 2004;Build 24
;;Per VA Directive 6402, this routine should not be modified.
; When a production instance of VistA sends a claim, the claim is
; sent to FSC and then to the clearinghouse, which sends the claim to
; the appropriate payer. The payer's response is returned to the
; clearinghouse and then to FSC, who returns the response to the site
; which sent the claim.
; When a non-production instance of VistA sends a claim, it goes to FSC
; and then to the clearinghouse test bed. Because the claim is flagged
; as being a test claim, the clearinghouse does not send the claim to a
; payer. The clearinghouse returns to FSC a boiler-plate response,
; indicating the claim was accepted and paid. FSC returns the response
; to the non-production instance of VistA which sent the claim. A non-
; production instance of VistA includes any account used by a
; development team for development and testing of new enhancements.
; The ECME Testing Tool (^BPSTEST) allows users in a non-production
; VistA to override some of the fields on the default response returned
; by the clearinghouse. The Testing Tool does not affect the outgoing
; claim data. The purpose of the Testing Tool is to facilitate testing
; by allowing the user to manipulate the default response returned by
; the clearinghouse when sending test claims.
; The Testing Tool does not ever run on production VistAs, only on non-
; production instances of VistA.
; Invoking the Testing Tool
; Two things must be true in order for the Testing Tool to be invoked:
; The system must not be a production system (i.e. $$PROD^XUPROD must
; be false); and the field PAYER RESPONSE TEST MODE on the file BPS
; SETUP must be set to 1/On. The Testing Tool may not be invoked from
; a production system, and on non-production accounts, the PAYER
; RESPONSE TEST MODE fields must be set to 1/On to make use of the
; Testing Tool.
; While test/mirror accounts at production sites are non-production
; systems, the Testing Tool will never be used in these systems since
; the field PAYER RESPONSE TEST MODE will never be set to 1/On. These
; accounts generally do not have ePharmacy communication set up with
; FSC, so they will never send test claims.
; Using the Testing Tool
; There are several VistA menu options and actions that can initiate
; the submission of a claim. If the process is a foreground process,
; then just before the building and sending of the claim, the user is
; given the option of entering response overrides (if the system is a
; non-production system, and the PAYER RESPONSE TEST MODE field is set
; to 1/On). The user may also enter response overrides for an
; Eligibility transaction or a Reversal.
; The Testing Tool does allow for overrides to be entered for a claim
; which will be submitted in the background. The menu option BPS
; SELECT OVERRIDES allows the user to enter overrides which will then
; be applied to the incoming claim response when the claim is submitted
; in the background (such as CMOP or auto-reversal). This menu option
; does not exist in production systems.
; The claim submission code will call the subroutine GETOVER^BPSTEST,
; which will indicate to the user that payer overrides are enabled at
; that site. The system will prompt the user "Do you want to enter
; overrides for this request?". If the user enters "No", then they
; will not receive any further prompts related to the Testing Tool. No
; values on the incoming response will be overridden with any user-
; entered values. If the user enters "Yes", then the system will allow
; the user to enter override values for a variety of fields, for
; example: Response (rejected, paid, duplicate, stranded), Total
; Amount Paid, Copay Amount, Ingredient Cost Paid, Next Available Fill
; Date, Payer ID Qualifier, etc.
; When the incoming claim response comes in, the system parses the
; values and stores them in the file BPS RESPONSES. (Data fields may
; also be stored on the REJECT INFO sub-file of the PRESCRIPTIONS
; file.) If the system is a non-production system, and the PAYER
; RESPONSE TEST MODE field is set to 1/On, then the subroutine PARSE^
; BPSECMPS will call SETOVER^BPSTEST. If any overrides had been
; entered for the claim esponse, those values will override the values
; received from the clearinghouse on the claim response.